title: Preadmission interventions to prevent postoperative complications in older cardiac surgery patients: a systematic review.
abstract: OBJECTIVE
  The literature on postoperative complications in cardiac surgery patients shows high incidences of postoperative complications such as delirium, depression, pressure ulcer, infection, pulmonary complications and atrial fibrillation. These complications are associated with functional and cognitive decline and a decrease in the quality of life after discharge. Several studies attempted to prevent one or more postoperative complications by preoperative interventions. Here we provide a comprehensive overview of both single and multiple component preadmission interventions designed to prevent postoperative complications.
  
  
  METHODS
  We systematically reviewed the literature following the PRISMA statement guidelines.
  
  
  RESULTS
  Of 1335 initial citations, 31 were subjected to critical appraisal. Finally, 23 studies were included, of which we derived a list of interventions that can be applied in the preadmission period to effectively reduce postoperative depression, infection, pulmonary complications, atrial fibrillation, prolonged intensive care unit stay and hospital stay in older elective cardiac surgery patients. No high quality studies were found describing effective interventions to prevent postoperative delirium. We did not find studies specifically targeting the prevention of pressure ulcers in this patient population.
  
  
  CONCLUSIONS
  Multi-component approaches that include different single interventions have the strongest effect in preventing postoperative depression, pulmonary complications, prolonged intensive care unit stay and hospital stay. Postoperative infection can be best prevented by disinfection with chlorhexidine combined with immune-enhancing nutritional supplements. Atrial fibrillation might be prevented by ingestion of N-3 polyunsaturated fatty acids. High quality studies are urgently needed to evaluate preadmission preventive strategies to reduce postoperative delirium or pressure ulcers in older elective cardiac surgery patients.
authors.affiliation: Nursing and Paramedical Care for People With Chronic Illnesses, University of Applied Science Utrecht, Faculty of Health Care, Bolognalaan 101, 3584 CJ Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Electronic address: Roelof.Ettema@hu.nl.
authors.forename: Roelof G A
authors.initials: RG
authors.lastname: Ettema
authors.affiliation: Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: Van Koeven
authors.affiliation: Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Peelen
authors.affiliation: Professor of Anesthesiology, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Cor J
authors.initials: CJ
authors.lastname: Kalkman
authors.affiliation: Nursing and Paramedical Care for People With Chronic Illnesses, University of Applied Science Utrecht, Faculty of Health Care, Bolognalaan 101, 3584 CJ Utrecht, The Netherlands; Professor of Nursing Science, Department of Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Schuurmans
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D010343:Patient Admission; D011183:Postoperative Complications / Q000517:prevention & control*; D057234:Preoperative Period
keywords: Cardiac surgical procedure; Older patients; Postoperative complications; Preadmission preventive measures